CARDIAC

CATYHETERIZATION – CARE
OF PATIENT

Date: 19 / 12 / 2021
1.INTENTION / PURPOSE

To provide information/ instructions regarding the pre and post nursing care to a patient submit to diagnostic
/interventional cardiac catheterization

2.GLOSSARY / TERMS DEFINITION

PCI - Percutaneous Coronary Intervention

RN – Register Nurse

MRP – Most Responsible Physician

3.GUIDELINES

3.1 A Register Nurse will provide pre/post procedure care to the patient submit to cardiac
catheterization. It is the responsibility of the Nurse in charge of the patient care to prepare the patient for
the procedure. All this information should be documented on THOM and should handover to the Cath
Lab nurse that receive the patient.

3.2 The Interventional Cardiologist or designate obtains informed, written consent from the client, family
or legal guardian.

3.3 Outpatients will be booked by the Cath Lab and admitted to In Intensive care Unit on the day of the
procedure.

3.4 Patient should be NPO for four hours prior to procedure or as ordered by the Cath Lab.

3.5 For radial approach, the interventional cardiologist or designate will be responsible to assess for
adequate ulnar circulation in the hand which will be used for the procedure (see module trans radial
approach in Cath Lab)

3.6 Length of bed rest post-procedure is determined by location, condition of access site, and lingering
effects of procedure sedation.

3.7 Patient should not drive for 48 hours after the procedure

3.8 All patients should receive a copy of the coronary angiogram report or percutaneous coronary
intervention report and discharge instructions (appendix 4, 5, 6)

3.9 After admission a Register Nurse will:

3.9.1 Do pre-procedure teaching and explain the necessary preparation. (See Guide of
information’s regarding a patient submit to coronary angiogram, angioplasty and stent)

3.9.2 Obtain baseline vital signs and a physical assessment - including cardiac assessment (see
guidelines for assessment of cardiovascular system) and the assessment of peripheral pulse (see
guidelines of assessment of peripheral pulses).

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 3.9.3 During the preparation of the patient, should be assessed and confirmed the following patient’s
data and Vital Signs.

 Height.
 Weight.
 Temperature.
 Heart Rate.
 Blood Pressure.
 Pain.
 SPO2 level.
 Glucose levels.
 Bladder Empty.
 Pregnancy test if female patient in reproductive age.
 Blood Products availability, if applicable.
 Allergies to Food, Medication and Others.
 Current Medication – Patient’s should be checked for medication that might interfere with their
hemodynamic state during the procedure like Anti-hypertensive, anti-coagulants, anti-diabetics
and insulin.
 Pre-Medication. If prescribed should be administered and documented on patient’s notes. If not
should also be documented the reason why they were not administered.
 Special attention – any alterations at vital signs, Hight level of creatinine, Hight or low Potassium
level , alterations on INR level , ECG alterations , any king of allergy specially allergy to fish or
seafood must be communicate immediately to the patient physicians

3.9.4 Instruct the patient to wear a hospital gown and ensure that is one, open at front .

3.9.5 - Ensure the patient has patent IV access, preferably 20G in the left arm and started normal
saline at 50 ml /m

3.9.6 –Review the blood test results regarding CBC, White cells, PTT and INR (if applicable) and inform
Cath lab team if any abnormal result

3.9.7 - Review if any recent ECG done.

3.9.8 - The Cath Lab must be notified of any abnormal blood work or ECG changes.

3.9.9 - Clip the hair at the anticipated access site with surgical clippers.

3.9.9.1 – Right radial

3.9.9.2 - Left radial

3.9.9.3 – Both groins ( the shaving must be from umbilicus till above the knee as physicians
preference )

3.9.10 Remove all of patient’s jewelry and contact lenses. eyeglasses, hearing aids and dentures may be
worn by patient.

3.9.11 Review all the patient medication taken at home

3.9.11.1 If patient preview taken warfarin check when the last dose, review results of INR test.

3.9.11.2 Pre procedure the INR must be less than 2

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 3.9.11.3 If patient is on IV heparin, check the order regarding the need or not the discontinued.

3.9.11.3.1 - Check post procedure orders to determine if/when it needs to be restarted.

3.9.11.4 – If patient is on Low-molecular-weight heparin (LMWH), Dabigatran, Rivaroxaban or

other oral anticoagulant check when the last dose and confirm with Physician what was the
correct date to be holding the dose prior to the procedure

3.9.11.5 - Give the medications as oral cardiac medications, ASA and antiplatelets, unless directed
otherwise by the cardiologist.

3.9.11.6 - Review the order referred to hold Metformin and Metformin-containing medications
prior to procedure and for 48 hours following unless directed otherwise by the cardiologist.

3.9.11.7 - Check with the Physician, what the order, regarding diuretics, insulin and other oral
diabetic agents.

3.9.11.8. – Pre procedure loading dose:

3.9.11.8.1- If patient already on daily dose of Aspirin 81 mg for a week, no need loading
dose

3.9.11.8.2 - If patient is not on daily dose of Aspirin 81 mg for a week, or any dose,
administered 300 mg of aspirin as loading dose

3.9.11.8.3 - If patient already on daily dose of clopidogrel 75 mg for a week, no need

loading dose

3.9.11.8.4 - If patient is not on daily dose of clopidogrel 75mg for a week, or any dose,
administered 600 mg of clopidogrel as loading dose

3.9.11.9 - Contact patient physician or Cath lab if any dough regarding medication

3.9.12 – Ensure that the patient go to bathroom before procedure (empty bladder)

3.10- Fill the Safety checklist for cardiac interventional procedure, Pre Cath-assessment- Nursing
(Appendix 1)

3.11 - Transfer patient to Cath Lab via stretcher with the current and old charts.

3.12 - At post procedure:

3.12.1 The patient will be returned to the unit via stretcher, accompanied by the Cath lab nurse

3.12.2 - All patients after procedure should be transferred from stretcher to bed with a Register Nurse
assistance.

3.12.3 – The Cath lab nurse will hand over the patient regarding the procedure, medication and nurse
care provided and needed and the procedure report. and post procedure orders (appendix 3)

3.12.4 - Upon patient return to the unit, immediately obtain and documented a post-procedure
assessment which includes vital signs, condition of puncture site, intactness of dressing and circulation
(pulse quality), sensation and movement on the limb distal to the access site.

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3.12.5 – If not done already at Cath lab obtain ECG pos procedure or if patient present chest pain (see
Guidelines Obtain a ECG)

3.12.6 - Ensure any vascular clamp (i.e., femostop, TR radial band), if in place, is in the correct position
and adequate pressure is applied and no bleeding noted.

3.12.7 - If artery femoral sheath still in situ, attach the arterial sheath to a pressure tubing/transducer with
monitor to obtain invasive pressure.

3.12.8 - If was used femoral access, The femoral sheath will be removed as ordered by the physician or
protocol (see guidelines femoral sheath removal) .

3.12.9 - If radial access used, TRband will remove as protocol (see guidelines for TRband removal)

3.12.10 - Pos procedure assessment of vital signs.

3.12.10.1 - Perform minimum vital signs (heart rate, blood pressure, respirations)

 Q15 min x 1 hour

 Q30 min x 1 hour
 Q hourly x 2 hour

3.12.10.2 - Perform minimum checks of access site and distal circulation

 Q15 min x 1 hour

 Q30 min x 1 hour
 Q hourly x 2 hour
 Q 4 x 18 hours

3.12.11 Resume client’s pre-procedure diet upon return to the unit if radial access used

3.12.10.1 if femoral sheath still in situ, patient must keep NPO until sheath removed

3.12.12 Maintain bed rest as per physician orders.

3.12.13 - During bed rest the client should keep the affected limb straight. For client comfort the head of
the bed may be elevated 10-20º or reverse Trendelenburg may be used. The client may log roll.

3.12.14 – Normally the duration of bed rest is determined by the condition and location of the access
site, but bed rest times are as follows unless directed otherwise by the interventional cardiologist:

 Femoral access site: bed rest for 4 to six hours unless different order by operator posts sheath
removal in case of femoral artery.
 Femoral access site with use of a closure device: may sit at 30º immediately, but on bed rest
for 2 hours post procedure.
 Radial or brachial access site: may ambulate immediately if the nurse determines the effects of
the procedure sedation are minimal.

3.12.15 If is the case and following the physicians orders, remove femoral sheath as guideline and record
at THOM vital signs and pulses as Pre/post sheath removal nursing management ( appendix 2)( see
guidelines for femoral sheath removal )

3.12.16 - Keep puncture site dressing in place until the following morning.

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3.12.17 - During the discharge process the Primary Nurse must explain and instructed the patient and
family to follow the instructions post catheterization.

3.12.17.1 - Medications:

3.12.17.1.1 - Resume your current medications unless instructed otherwise by your

cardiologist

3.12.17.1.2 If you were taking Metformin (Glucophage, Avandamet, Glycon, for your
diabetes prior to your procedure, restart this medication two days following your
procedure, unless instructed otherwise by your cardiologist.

3.12.17.1.3 - If you were given a prescription for Plavix (Clopidogrel), Ticagrelor (Brilinta)
or Effient (Prasugrel) have this filled today to immediately continue the medication

3.12.17.1.4 Reinforce near the patient and family how important is that him take the
medication every day.

3.12.17.1.5 Inform the patient that if his puncture site is uncomfortable, he may take an
over-the-counter medication for this as Panadol.

3.12.17.2 - Driving:

 Do not drive for 48 hours following your procedure. Your cardiologist may give
you added restrictions based on your individual circumstance.
 If you drive a commercial vehicle, ask your cardiologist when you may return to
driving.

3.12.17.3 - Return to work / activity:

 Your cardiologist will let you know when you are able to return to work.
 Avoid heavy lifting (over 10 lbs) for the next 5-7 days.
 If you are planning a trip that involves air travel in the next month, talk with your
cardiologist to make sure that you are fit to travel.
 If you have questions regarding sexual activity, speak to your cardiologist.

3.12.17.4 - Hygiene

 If you still have a dressing on your puncture site, remove it the next day. Gently
wash the area with soap and water and leave it open to air.
 Avoid bathing in a hot bath, swimming or hot tubs for the next week as this may
cause the puncture site to bleed. You may take a shower.

3.12.17.5- Appointments

12.17.5.1- Inform and give to patient or the family the appointment with the date when
he needs to see the Doctor again and or if he also has blood to do.

3.12.17.6 - Advice the patient If he live out of town and have been discharged the same day as
the procedure, it is recommended that stay in the city overnight.

3.12.17.7 - Instruct the patient regarding the care to have after the procedure depending on the
site puncture. Reinforce all the next points:

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 3.12.17.7.1 Radial (wrist) Approach

 If your wrist site begins to bleed, apply firm pressure for 10 minutes. If you are
not able to stop the bleeding, return to the hospital.
 For the next 5-7 days avoid any activity which involves excessive use of that wrist.
(i.e., golfing, knitting, computer work)
 Your hand should be its normal color and have normal sensation.
 You may notice some bruising at the puncture site, this is normal and will go
away in 2-3 weeks.
 A small lump may remain at the site; this is normal and should go away in 2-4
weeks.

3.12.17.7.1.1 Instruct the patient to contact his doctor or hospital if any of the
following occur:

 Your wrist or hand becomes painful, cold, discolored, swollen or red.

 You develop a fever or drainage from the puncture site.
 You develop severe swelling or pain in your arm above the puncture site.

3.12.17.7.2 - Femoral (groin) site – Discharge Information

 If your groin puncture site begins to bleed, lie flat and apply firm pressure over
the site or have someone else do this for you. Return to the hospital.
 Local tenderness at the site may last for a week.
 Bruising at the site is normal and this should go away in a few weeks.
 An increase in swelling or pain at the site is not normal. Call your family doctor.
If unable to reach your family doctor, return to hospital.
 A lump the size of your thumb may be felt over the site or develop over the site
in the next week. If this gets larger or becomes painful, see your family doctor.

3.12.17.7.2.1. Instruct the patient to contact his doctor or hospital if any of the
following occur:

 Your leg or feet becomes painful, cold, discolored, swollen or red.

 You develop signs of infection at the puncture site (redness, swelling or drainage)
or develop a fever
 You develop severe swelling or pain in your leg above the puncture site.
 If you develop signs of infection at the puncture site (redness, swelling or
drainage) or develop a fever, call your family doctor

3.12.18 - Give to patient/family the brochure regarding the post procedure instructions.

3.12.19 - Give time to patient /family read the brochure

3.12.20 - Be available to escalate any doubts and concerns.

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4. RELATED REFERENCES

4.1 Amy Scheuler, Management of Transradial Access for Coronary Angiography 2012 Journal of
Cardiovascular Nursing Month 12

4.2 Oxford handbook of a Cardiac Nursing , 2nd Edition, Kate Olson, 2014

4.3 Invasice Cardiology , A Manual for Cath Lab Personnel, 3 nd Edition

4.4 An introduction to Doppler in https://www.oxfordhealth.nhs.uk/wp-content/uploads/2015/08/An-

introduction-to-Doppler.pdf visited 2/10/2021

4.5 Guidelines of assessment of peripheral pulses module

4.6 Guidelines of using the doppler ultrasound

4.7 Guidelines for assessment of cardiovascular system

4.8 Guidelines for femoral sheath remove

4.9 Guidelines for Trband remove

4.10 Guidelines Obtain a ECG

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APPENDIX 1

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APPENDIX 2

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APPENDIX 3

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APPENDIX 4

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APPENDIX 5

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APPENDIX 6

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APPENDIX 7

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 Policy /SOP Title:

Policy / SOP Number:

Name: Isabel Paulo

Prepared By: Signature:

Date: 19/12/2021

Name: Jose Batista

Reviewed By: Signature:

Date: 21/12/2021

Name:

Reviewed By: Signature:

Date:

Name:

Approved By: Signature

Date

Revision control
VERSIO
Status Revision Date Summary of Changes Author
N
1

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